Every year, during Eye Injury Prevention and Halloween Safety Month, I begin to get questions from friends and colleagues about the safety of decorative (also called "cosmetic," "circle," "costume," or "non-prescription") contact lenses. For the uninitiated, "circle lenses," which first became popular in Asia about 10 years ago, are contact lenses that give the wearer a doll-eyed or doe-eyed "innocent" look:

Venus Palermo, the "Human Barbie Doll"

What are Circle or Cosmetic Contact Lenses?

Circle contact lenses, also known as "big-eye contact lenses" and "circle lenses," are cosmetic contact lenses that make the eye's iris appear larger. They have become a trend in Japan, South Korea, and China, and are largely produced in these countries.

Circle lenses are tinted not only in areas that cover the iris of the eye, but also prominently in the extra-wide outer rim of the lens. The result is the appearance of a bigger, wider iris and creation of an illusion of large eyes.

The lenses are popular among teenagers and young adults. Many people consider circle lens to be a fashion accessory, rather than a medical device.

These lenses might be just another beauty fad if not for the facts that they are contraband and that eye doctors express grave concern over them. It is illegal in the United States to sell any contact lenses — corrective or cosmetic — without a prescription, and no major maker of contact lenses in the United States currently sells circle lenses.

Sites that sell contact lenses approved by the Food and Drug Administration (FDA) are supposed to verify customers' prescriptions with their eye doctors. By contrast, circle lens websites allow customers to choose the strength of their lenses as freely as their color.

To avoid a real-life Halloween horror story – going blind because of a costume accessory – the American Academy of Ophthalmology is warning the public against wearing costume contact lenses purchased without a prescription. These illegally-sold cosmetic lenses may not be sterile and can cause a host of serious eye problems capable of morphing a fun Halloween night into a nightmare.

In 2005, after reports of them causing eye injuries and infections, the FDA classified all contact lenses as medical devices and restricted their distribution to licensed eye care professionals, effectively banning sales of non-prescription contact lenses.

Despite that, these items remain available on the Internet, in convenience stores, and at flea markets. Here are four frightening ways that non-prescription decorative lenses can hurt your eyes:

Scratches: Because over-the-counter lenses are not fitted and sized for the person wearing the contacts, they can easily scrape the outer layer of the eye. The resulting corneal abrasions can cause redness, light sensitivity, discharge, pain, plus the feeling that something is stuck under the eyelid.

[Editor's note: The cornea is a transparent dome-shaped tissue that forms the front part of your eye. It functions as a window and allows light to enter your eye. It also begins the process of focusing light rays that allow you to see words and images clearly. The cornea provides 65-75% of your eye's focusing power.]

Sores: Costume contact lenses can literally create an eye sore called a corneal ulcer, with symptoms similar to corneal abrasions. The ulcers sometimes appear as a white dot on the iris – the colored part of the eye. When the ulcers heal, they can scar over and can in some cases permanently affect vision.

Infections: Both corneal abrasions and ulcers create openings in the eye, making them more vulnerable to bacteria, viruses and amoebas. All of these organisms can cause serious eye infections known as keratitis. Some infections, such as herpes simplex, can be recurring and difficult to eradicate, while a number of bacteria have become resistant to common antibiotics.

Blindness: In the most extreme cases, complications from wearing costume contact lenses may require surgery or end in blindness. For instance, extensive scarring from an infection can distort the cornea or make it opaque, requiring a corneal transplant to restore vision.

Complications from Cosmetic/Costume Contact Lenses

Because most purchases of cosmetic, costume, and circle contact lenses are neither prescribed nor regulated, eye infections are more common than you might think. And infections, in some cases, can lead to blindness. Here are some additional complications that can occur from purchasing online or "over-the-counter" contact lenses:

depriving the cornea of sufficient oxygen, which can lead to infection and blindness

Cosmetic/Costume Contact Lens Safety Guidelines

To wear decorative contact lenses safely this Halloween, or any time of year, the American Academy of Ophthalmology recommends following these guidelines:

Only buy decorative contact lenses from an eye care professional, such as an ophthalmologist or optometrist, or a retailer that requires a prescription and sells FDA-approved products.

If you don't already have a contact lens prescription, obtain a valid prescription and eye exam from an ophthalmologist or optometrist.

Even if you have regular or unimpaired vision, a comprehensive eye exam and prescription are mandatory in order to fit the right size contacts. Do not fall victim to false advertising claims and lenses labeled as "one size fits all" or "no need to see an eye specialist."

Follow the directions for cleaning, disinfecting and wearing the lenses. Contacts that are left in for too long or that are not properly cleaned and disinfected can significantly increase the risk of an eye infection.

Never share contact lenses with another person or wear expired lenses.

Another Emerging Danger: Eye Tattoos!

A Canadian woman nearly lost her eye after undergoing a dangerous and increasingly popular procedure to permanently color in the whites of her eyes.

Catt Gallinger, a 24-year-old model, had sought out a "sclera tattoo" — a relatively new trend in which people get ink injected into their eyeball to turn the sclera, or the white part of the eyeball, into a different color. Gallinger's procedure last month went wrong and left purple ink oozing out of her eye, which quickly became swollen, infected and painful.

[Editor's note: The sclera is a tough white outer coating of fibrous tissue that covers your entire eyeball (all the way around) except for the cornea. The muscles that move the eye are attached to the sclera. The name sclera comes from the Greek word "skleros," which means "hard."]

Gallinger said she expects to undergo eye surgery to remove the ink next week, but the vision in her right eye will likely never go back to normal. She's now speaking out against the dangers of sclera tattoos to spread awareness about the life-changing risks the procedure poses.

A sclera tattoo is not exactly a tattoo, although it is permanent. It happens when a mixture of ink and saline is injected into the eye through a small needle. The most popular color is black, which is perhaps the most shocking, experts say. The procedure is typically done by body modification artists — who focus on altering the human body with procedures that range from piercings to giving a person a forked tongue — rather than tattoo artists.

To all of our valued readers: Please have a happy – and safe – Halloween by following these critically important eye safety guidelines.

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